Just because the US Supreme Court tells Texas that the Affordable Care Act is constitutional, that doesn't mean Gov. Rick Perry is going to enforce it. Instead, in a predictable fit of hubris and grandstanding, this morning Perry announced he will not enact the law of the land, and will instead leave it to the Feds.

Now let's remember: Texas already has the highest percentage of uninsured citizens of any state in the US, and a new study by the US Department of Health and Human Services shows that Texas has the worst healthcare of any state.

So Perry's response to this catastrophe? In a letter to U.S. Health and Human Services Secretary Kathleen Sebelius, Perry said he will not implement an health insurance exchange. Also, he will not expand Medicaid to cover families earning below 133% of the Federal poverty level. That leaves an estimated 1.5 million Texans eligible for expanded Medicaid coverage without healthcare and leaving an estimated $13 billion in Federal funds to be distributed to other states.) Perry wrote, "I will not be party to socializing healthcare and bankrupting my state in direct contradiction to our Constitution and our founding principles of limited government."

Instead, he will keep doing what Texas has always done: Refuse to create an affordable health care system, and turn county hospitals and clinics into the first and last line of medical care for many citizens. Unfortunately, as is well documented, that is pretty much the most expensive and ineffective way to provide health care. As the Federal study shows, Texas is classified as "weak" in its preventative care provision. It also costs a lot more. Implementing Medicaid expansion would cost $6 billion a year, but the comptroller's office calculate Texas hospitals currently lay out $10.2 billion in uncompensated care. By rejecting the Medicaid expansion, Perry seemingly will cost the tax payers more. Not so conservative after all.

But expect some quick Perry packpedalling on this: After all, the legislature was looking forward to getting its hands on this issue next session.

In a statement, the Texas Democratic Party called Perry's decision "both cruel and negligent." Pointing to the federal funds that he is rejecting, TDP spokeswoman Rebecca Acuña said, "Rick Perry’s Texas solution is to let Texans stay ill and uninsured." She added, "That is not a health care plan. Once again Perry is putting partisan political pandering in front of the interests of Texas."

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